Healthcare Provider Details

I. General information

NPI: 1144068586
Provider Name (Legal Business Name): ELENA GARCIA QUEZADA LVN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2024
Last Update Date: 07/18/2024
Certification Date: 07/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9380 BIGLER DR
PLANADA CA
95365-8042
US

IV. Provider business mailing address

9380 BIGLER DR
PLANADA CA
95365-8042
US

V. Phone/Fax

Practice location:
  • Phone: 209-658-6497
  • Fax:
Mailing address:
  • Phone: 209-658-6497
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number737118
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: